Workers' Compensation

This page briefly explains how the Minnesota Workers' Compensation Law
applies to work-related injuries or illnesses that happen on or after Oct. 1,
1995. This is not a complete description of the workers' compensation
system. The complete laws covering workers' compensation can be found in the
Minnesota Statutes.

This non-copyrighted material is reproduced, with our reformatting and
graphics, from the website of the Minnesota Department of Labor and Industry, to
whom we express our sincere appreciation. The links section of our home page
includes a link to the Department of Labor and Industry where changes and
updates to this material may be found.

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On this page

Disclaimer

Workers' compensation overview

Helpful hints for injured workers

What is the purpose of workers' compensation?

Who pays the workers' compensation benefits?

Who is the insurer?

What about worker's rights?

Note to union members

What should I do when I am injured?

What does the employer do?

What does the insurance company do?

What if my claim is denied?

What benefits do I get?

Who chooses my doctor?

What if I need help returning to work?

What are vocational rehabilitation services?

How do I get more information?

Problems with my claim

Fraud warning

Who can answer my questions?

Workers' compensation overview

Workers' compensation:

helps you return to work as soon as reasonably
possible;

returns you, as close as possible, to the income you
had before the injury;

provides compensation for permanent loss of function
or the inability to earn an income;

pays part of your wage loss;

pays for all reasonable medical and vocational
rehabilitation costs related to the injury;

Keep track of your mileage for vocational
rehabilitation and medical visits to qualify for reimbursements.

Save notes of phone conversations.

Put your name, Social Security number and date of
injury on all papers and forms sent to the Department of Labor and Industry
to help process them quickly. Clearly identify your employer and its
insurer.

Inform your employer about your medical progress and
plans to return to work.

What is thepurpose of workers'
compensation?
The workers' compensation system provides benefits if you become injured or ill
from your job. Workers' compensation covers injuries or illnesses caused or made
worse by work or the workplace. Workers' compensation does not cover
self-inflicted injuries or injuries caused by intoxication. You do not have to
prove that the accident or illness was your employer's fault or that it was not
your fault.
Workers' compensation:

pays for reasonably necessary medical services related
to the injury;

pays compensation for part of your wage loss or
inability to earn a full income;

pays compensation for permanent loss of use of or loss
of body function;

pays benefits to dependents for a work-related death;

pays for vocational rehabilitation services if you
cannot return to the job or to the employer you had before your injury.

Whopays the
workers' compensation benefits?
Most employers purchase workers' compensation policies from insurance companies.
Some employers are approved to be self-insured; they pay the benefits
themselves.

Either insurance companies or approved self-insured employers pay benefits to
injured workers for wage-loss and permanent loss of use of body functions.
Insurers pay the medical and vocational rehabilitation costs directly to the
service providers. Insurers reimburse employees for medical expenses such as
mileage and prescriptions.

State law sets the benefit levels. Insurers file benefit payments information
with the Department of Labor and Industry. The department checks that the
benefits paid by the insurers are correct. Unless your employer violates the law
by being uninsured, the department does not pay benefits.

Who is the workers' compensationinsurer?
Employers must display the Employee Rights and Responsibilities poster
which includes the name of their workers' compensation insurer company. If you
cannot find the poster at your workplace or if the insurer's name is not on it,
ask your employer. You can also call the Department of Labor and Industry's
Insurance Verification Unit at (651) 296-2170 or toll-free at 1-800-342-5354 to
learn the insurer's name.

What about the worker'srights?
State law backs your right to file for workers' compensation benefits. You do
not have to pay for any workers' compensation benefits. State law requires
employers to have workers' compensation insurance to pay for all workers'
compensation benefits or be approved for self insurance. Your employer cannot:

take the cost of workers' compensation insurance from
your wages;

prevent you from reporting your work-related injury;

threaten you or take action against you for filing for
workers' compensation benefits.

The Department of Labor and Industry's workers' compensation files are
private; besides state agency staff, the files contents can be examined only by:

the employee;

the employer;

the appropriate insurer;

the dependents of a decreased employee; or

a person who has been authorized in writing by the
employee to view it.

The employee has access to his or her medical record and the right to release
access to it. The employer, insurer and the Department of Labor and Industry can
obtain written medical information directly related to a current claim for
workers' compensation without the need for authorization by the employee. Anyone
else requesting copies of existing medical records and reports must get signed
authorization from the employee and they must provide the signed authorization
and a written request to the health care provider.

Note tounion
members
Some unions and employers, especially in the construction industry, may have
negotiated different methods for providing some benefits. Contact your union
representative for further information.

What should I do when I aminjured?

Do not wait, report your injury to your supervisor as
soon as possible.

Get prompt medical care -- read Who chooses my
doctor, below.

Inform your employer about your medical condition and
when you can return to work.

Call the insurer if you have questions or problems
with your claim. Call the Department of Labor and Industry if you continue
to have problems.

After two weeks from the first day of lost time or
lost wages resulting from the injury, you should contact your employer or
insurer if:

you have not received a check for lost wages, or

you have not received a Notice of Insurer's
Primary Liability Determination from the insurer saying it is denying
workers' compensation benefits.

What does theemployer do?

Your employer fills out the First Report of Injury form;

Your employer then sends the completed First
Report of Injury to the insurance company, unless your employer is
self-insured.

What does theinsurer do?

After you have reported the injury, the insurer
investigates the injury report and makes an initial decision about whether
to accept or deny your claim.

If you are disabled for more than three days because
of the injury, the insurer must send a copy of the First Report of
Injury to you and file the form with the Department of Labor and
Industry. The insurance company or the self-insured employer makes all
benefit payments. The Department of Labor and Industry does not pay benefits
unless your employer is uninsured.

After you have reported the injury to your employer, the insurance company or
the self-insured employer investigates the injury report, and initially decides
whether the injury is work-related.

If you are unable to work more than three days because of the injury, the
insurance company or self-insured employer has to :

send a copy of the First Report of Injury to
you and file it with the Department of Labor and Industry;

You should contact your employer or its insurance company if after two weeks
you have not received a check for lost wages or a notice from the insurance
company or self-insured employer saying it is denying workers' compensation
benefits; or if your medical bills are not paid within one month after the
doctor submits them to the insurer or self-insured employer.

What if my
claim is denied?
If the insurance company or self-insured employer refuses to pay your claim, you
will receive a Notice of Denial of Liability. The notice must give the
reason and facts explaining why your claim was denied.

If you disagree with the denial, you should first talk with the claim
adjuster. The claim adjuster is the person at the insurance company or
self-insured employer who handles your claim. Read the section Problems with
my claim, below.

You may need help returning to work even if your claim for benefits has been
denied. Call or e-mail Department of Labor and Industry's Vocational
Rehabilitation Unit to request a rehabilitation consultation. You can call the
Twin Cities number directly at (651) 297-1114 or call the toll-free number,
1-800-342-5354, and ask for the Vocational Rehabilitation Unit.

What
benefits do I get:

...if I am temporarily unable to work?
You will receive wage-loss benefits if you are unable to work more than three
days because of your injury. The benefit is called Temporary Total Disability
(TTD) and is designed to replace two-thirds of the before-tax weekly wages at
the time of the injury. The box below shows the upper and lower benefit limits.

At first, TTD is not paid for the first three days you are unable to work.
TTD is paid for the first three days if you cannot work and it has been 10 or
more days from the first day of lost time. The insurer or self-insured employer
must send your benefit checks at the same time you were normally paid.

Weekly workers' gross weekly
wage

Compensation rate

$922.50 or more

$615

$156 to $922.50

2/3 of wage

$104 to $156

$104

Less than $104

total wage

If your wages changed weekly before you were injured, call the claim adjuster
for information about how to compute your average wage. Your employer may need
to send weekly pay information to the insurer.

TTD is paid for up to 104 weeks, until one of the following occurs:

you return to work;

you have been released to work without any physical
restrictions from the work injury;

you retire for reasons other than your injury;

90 days have passed after you reach maximum medical
improvement (MMI) or the end of an approved retraining program -- MMI is the
date when your injury has improved as much as a doctor says it can;

other events occur that can be legal reasons for
stopping your benefits.

The insurer or self-insured employer must send you a Notice of Intent to
Discontinue Benefits before stopping your ongoing benefits. In some legal
instances, your benefits can start again.

This is only a brief explanation of TTD benefit payments, call the Department
of Labor and Industry for more information about how the law applies to your
claim.

...if I return to work at a lower wage?
If you return to work and, because of the injury, you earn less than before your
injury, you may qualify for Temporary Partial Disability (TPD) benefits. TPD
pays two-thirds of the difference between your old wage and your new wage. A
maximum of 225 weeks of TPD can be paid for the period up to 450 weeks after the
date of injury.

...if my injury is permanent?
Some injuries are permanent, for example, you may have lost part of a finger or
your back will never function as it did before the injury. If you have a
permanent injury, you will receive Permanent Partial Disability (PPD) benefits.
The level of disability sets the amount of PPD benefits paid. PPD is paid in
weekly amounts after your temporary total disability benefit ends.

...if I never return to work?
Sometimes a work injury or illness prevents you from returning to any type of
work and then you may be eligible for Permanent Total Disability (PTD) benefits.
PTD benefits are two-thirds of your before-tax weekly wages, with a minimum of
65 percent of the statewide average weekly wage. PTD benefits have the same
upper dollar limit as temporary total disability, with an annual cost-of-living
increase starting four years after the injury date. Call the Department of Labor
and Industry for more details.

...if I lose my life?
Dependents of a worker who dies because of a work-related accident or disease
may be eligible for dependents' benefits. The weekly benefits are based on the
number of dependents and the worker's wage.

...if I need medical benefits?
Your workers' compensation insurer pays all reasonable medical bills for your
work-related injury; this includes chiropractic and physical therapy sessions.
The insurer will also pay for medical tests, prescriptions and mileage for
medical appointments.

The Medical Fee Schedule limits the amount insurers pay for
treatments. The Department of Labor and Industry has developed treatment
standards to help determine if treatment is reasonable. The doctor is not
allowed to ask you to pay additional fees or to pay for unnecessary treatments.
The insurer will not pay for treatments unrelated to the workers' compensation
injury.

Make sure your doctor is regularly sending all bills and other medical
information to the insurer. The insurance company may refuse to pay bills if the
doctor has not sent information that explains the services provided.

Who chooses mydoctor

...if there is a certified managed care plan?
Your employer must tell you if you are covered by a certified managed care plan.
The employer must post a notice that shows the name and phone number of a
contact person who can answer questions about managed care. The notice must also
have a 24-hour phone number that explains the services.

When you report an injury, your employer must tell you how to get treatment
from a doctor in the managed care plan. You may ask the employer, the insurer or
the managed care plan for a list of the doctors in the plan.

You must go to a doctor in the plan unless:

you need emergency medical care;

you have a history of treating with another doctor and
you want to continue to see that doctor;

you live or work too far from a doctor in the plan.
(There is a 30-mile limit in the seven-county Twin Cities area and a 50-mile
limit in all other areas of Minnesota.)

...if there is not a certified managed care
plan?
If your employer does not have a certified managed care plan, you may choose any
doctor. Your employer may also ask its own doctor to examine you.

Some employers that do not have a certified managed care plan have a group of
doctors to provide treatment for workers' compensation injuries. You are not
required to go to a doctor in this group for treatment of your work-related
injury.

...if I need surgery?
If your doctor determines you need surgery, you might want to talk with the
claim adjuster. A second opinion may be needed unless it is an emergency or you
and the insurer agree that a second opinion is not necessary. The treatment
standards contain information about surgery that will be approved. If you do not
want to have surgery, you cannot be forced to have surgery.

...if I am able to go back to work?
You may be able to return to work before you have fully recovered from your
injury. You may be able to return to the job you had before your injury, to a
similar job or to a different job.

Discuss your job duties and your activity level with your doctor. Based on
your medical condition, your doctor may set work restrictions. Ask your doctor
for a written statement of your work restrictions or a copy of a Report of
Work Ability and give it to your employer as soon as possible.

Your employer must try to provide work you can do within your restrictions.
The work should pay as close as possible to your old income. Many employers have
modified work injured workers can do while they are recovering from their
injuries. Employers with more than 15 workers can be penalized if they do not
offer work.

If you feel that the job offered is not appropriate given your work
restrictions, tell your employer, the insurer and your doctor. If this does not
correct the problem, you should call the Department of Labor and Industry.

Your temporary total disability benefits may be permanently discontinued if
you refuse a job consistent with an approved vocational rehabilitation plan, or
a vocational rehabilitation plan has not been filed and you refuse an offer of
gainful employment within your physical condition.

If you have permanent limitations, your employer might not have work you can
do. Then you may be eligible for vocational rehabilitation. For more
information, read What if I need help returning to work, below.

What if I needhelp
returning to work?
Talk with your employer and your treating doctor about going back to work. Your
employer may provide services to help you return to work. If you cannot return
to your employer because of your injury, vocational rehabilitation services may
help you find work with a new employer. Vocational rehabilitation might not
begin unless requested by you, your employer or the insurer.

What arevocational
rehabilitation services?
These services help injured workers return to suitable work; they include help:

changing job duties to fit abilities;

finding work with a different employer; and

training for a new job.

A qualified rehabilitation consultant (QRC) coordinates vocational
rehabilitation services. The QRC works with you, your health care provider, your
employer and the insurance company to help you return to work.

How do I ask for vocational rehabilitation?
You, your employer or the insurance company may ask for vocational
rehabilitation at any time. To ask for a vocational rehabilitation consultation,
you should notify the insurance company in writing. Your employer or the
insurance company might provide a QRC; you may select a QRC.

The next step is to meet with the QRC to learn if vocational rehabilitation
will help you return to work. If you are eligible for vocational rehabilitation,
the QRC will help plan the services you need.

You can choose which QRC you want to work with, until 60 days after the QRC
files a rehabilitation service plan. After that time, you and the insurer have
to agree on any QRC change. If you and the insurer cannot agree, you can file a
request for dispute resolution services at the Department of Labor and Industry.

How do I get moreinformation?
Call the Department of Labor and Industry for more information about vocational
rehabilitation or information about how to find a QRC. A vocational
rehabilitation information pamphlet can be mailed to you.

Problemswith my claim
Most workers' compensation claims are paid without any problems, but if you
think the insurance company is not paying you correctly or if your medical bills
are not being paid, you should follow these steps:

Call the claim adjuster -- write down the date, time
and adjuster's name for your records. Explain the problem and try to work it
out; many problems are fixed simply with a telephone call.

Make sure the insurance company really must pay for
what you want. For example, although the insurance company must pay for your
medical care, it does not usually have to pay for household services that
are not medically prescribed. Call the Department of Labor and Industry to
see if the law allows the benefit you think you should have.

Discuss your problem with a specialist at the
Department of Labor and Industry. The specialist will help you resolve the
dispute or help arrange for an informal conference. Most disputes can be
avoided if you and the claim adjuster are willing to reach an agreement.

If the problem has not been resolved, the Department
of Labor and Industry specialist can explain the dispute resolution options
and help you decide what is best for your problem. You may need to ask for a
formal hearing before a compensation judge by filing a Claim Petition
form. The specialist can send you any forms you need to start the
process.

Fraudwarning
It is a crime to lie or give false information to an insurance company to
receive workers' compensation benefits. The law states: "Any person who, with
intent to defraud, receives workers' compensation benefits to which the person
is not entitled by knowingly misrepresenting, misstating or failing to disclose
any material fact is guilty of theft and shall be sentenced pursuant to section
609.52, subdivision 3."

Employers and other parties who lie or give false information to gain at the
expense of others are also subject to prosecution for fraud. Information about
workers' compensation fraud should be sent to the Investigative Services Unit at
(651) 297-5797.

Who can
answer my questions?
Your employer or its insurance company can answer most questions about your
claim. If you need more help, contact the Department of Labor and Industry.